Hospital Pharmacy: Lecture Four
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Intravenous admixture drugs in hospital pharmacy
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Hospital Pharmacy: Lecture Four
- 1. Intravenous Admixture Drugs in Hospital Pharmacy Anas Bahnassi PhD RPh 2012 Anas Bahnassi PhD RPh
- 2. Lecture Objectives • Define and describe the different types of admixture solutions • Describe different routes/methods of parenteral drug administration • define common terminology associated with parenteral drug administration • describe the basic principles of aseptic technique • demonstrate appropriate aseptic technique used in the preparation of IV admixtures • describe the advantages and limitations of a pharmacy-based IV admixture service • describe the specialized equipment and supplies used in an IV admixture service, including TPN and chemotherapy • Anas Bahnassi PhD RPh 2012 describe the techniques and technology that may be used to increase efficiency and productivity of an IV admixture service
- 3. Admixture Preparations Sterile IV solutions that are prepared by using one or more medications or electrolytes and will be administered via the parenteral route Anas Bahnassi PhD RPh 2012 Irrigation Ophthalmic Intrathecal Solutions Solutions Solutions
- 4. Intravenous Admixture Preparations • Compounding sterile admixture medication has originally started to prepare sterile intravenous, intrathecal, ophthalmic, and irrigating solutions that were not available commercially • 40% of hospital inpatients receive IV preparations including replacing fluids and electrolytes, provide nutrition and administer Anas Bahnassi PhD RPh 2012 medication. • It can be administered in the hospital or to patients at home.
- 5. Pharmacist’s Roles in Admixture Pharmacists Monitor Parenteral Parenteral Drugs Solutions Experts Administer Parenteral Compound Solutions Preparations parenteral Anas Bahnassi PhD RPh 2012 Solutions Stability Compatibility
- 6. Pharmacist’s Responsibilities in Admixture Preparations The pharmacy must maintain a clean area out Contamination of the direct flow of traffic with a vertical or horizontal laminar air flow hood to prepare IV admixtures Pharmacy education should prepare pharmacrists to deal with problems of physical, Anas Bahnassi PhD RPh 2012 chemical, and therapeutic incompatibilities Compatibility and to design suitable alternatives
- 7. Pharmacist’s Responsibilities in Admixture Preparations Stability Drug stability information must be readily accessible to the pharmacist in order to determine optimum conditions for drug storage prior and after preparation Keeping a drug at ideal storage conditions will help to establish a reasonable expiration Anas Bahnassi PhD RPh 2012 date for the product. Inspection method to test product sterility and overall integrity must be instated
- 8. Advantages of Admixture Prepared by Pharmacists Errors Errors are reduced if a pharmacy based admixture program is instated When pharmacists prepare admixture preparations errors become less frequent. The use of standardized dosing charts, including precalculated drug doses and Anas Bahnassi PhD RPh 2012 dilutions contained in admixture area reduce the chance of error significalntly
- 9. Advantages of Admixture Prepared by Pharmacists Quality Pharmacists should design and enforce admixture preparation system that ensures quality of the prepared preparations This system should include policies and procedures that can be applied in centralized and decentralized settings Anas Bahnassi PhD RPh 2012 This system will provide a mechanism to monitored quality to the prepared preparations
- 10. Advantages of Admixture Prepared by Pharmacists Individual- ization Admixture preparations have the advantage of being prepared for each individual patient and administered according to certain directions tailored for the individual patient. Admixture preparations ensures the application of total pharmaceutical care as Anas Bahnassi PhD RPh 2012 the pharmacist prepares, administers , and monitor the patient therapy
- 11. Admixture Pharmacy System Process Check the solution against original order Anas Bahnassi PhD RPh 2012 Label against original prescription • Dose Determine • Diluent • Rate of Administration
- 12. Establishing an Admixture Pharmacy System Preparation Area Admixture Storage Systems Area SYSTEM COMPONENT Anas Bahnassi PhD RPh 2012 Policies and Personnel Procedures
- 13. Preparation Area Description Washable floor covered with vinyl Restricted Area or epoxy Refrigirator Laminar Flow Hoods Vertical Adequate Light Horizontal Preparation Tools Anas Bahnassi PhD RPh 2012 No Smoking Adequate Counter No Food Space No Drink
- 14. Policies and Procedures Stability Labeling Aseptic and Techniques Checking Compat- Quality IV ibility Assurance Profiling Auxiliary Preparation should be according to a policies Labels and procedures manual Anas Bahnassi PhD RPh 2012 Detailed information of preparation, labeling, storage, and expiring date determination should be accessible
- 15. Policies and Procedures Stability Place Environmental Conditions Environmental Conditions Diluents Used Stability is affected by Anas Bahnassi PhD RPh 2012 Other Drugs Stability and Sterility determine expiration date
- 16. Policies and Procedures Physical Precipitation Inactivation Compat- ibility Chemical Deterioration Types of incompatibilities Anas Bahnassi PhD RPh 2012 Therapeutic Interaction that lead to Increase the effect or show toxic effects
- 17. Policies and Procedures Aseptic Techniques IV Profiling A sterile parenteral dosage form is free from living microorganisms, particulate matter, and Anas Bahnassi PhD RPh 2012 pyrogens. Review preparation against patient’s current profile
- 18. Policies and Procedures Labeling and Checking Patient Name Bottle Sequence Environmental Number Conditions Name and amount of each drug Name and volume of admixture Labels should reflect the information provided in the prescription Anas Bahnassi PhD RPh 2012 Preparer initials Auxiliary Labels Preparation and Date and times of Flow Rate Expiration dates Administration
- 19. Policies and Procedures Quality Assurance System to check aseptic environments and the pharmacist’s access to both patient’s profile and final product provide more stringent Anas Bahnassi PhD RPh 2012 quality control over parenteral therapy Admixtures of drugs not available commercially can be prepared using the powder form. The resulting solution should be filtered before addition to IV bag
- 20. Policies and Procedures Note Strength Activate before Protect from light use Auxiliary Required to avoid fatal errors Labels Anas Bahnassi PhD RPh 2012 Caution: For epidural use Chemotherapy Do Not Refrigirate only Agent
- 21. IV Room Equipment Laminar Flow Refrigerator HEPA Filteration References Slows microbial Vertical or growth Horizontal Handbook of Injectable Drugs Needle means Anas Bahnassi PhD RPh 2012 Check every 6 contamination months Compatibility and compounding charts
- 22. IV Room Charts Examples Anas Bahnassi PhD RPh 2012
- 23. IV Room Personnel Training Organized Regular Job Description Specialization Intense Who will do what Distribution Anas Bahnassi PhD RPh 2012 Module Based
- 24. IV Room Storage Area The prepared Mixture Refrigirator IV Room Admixture Systems Anas Bahnassi PhD RPh 2012 Systems require little involvement of actual compounding, it helps with general needs not special orders
- 25. Hospital Pharmacy Anas Bahnassi PhD RPh abahnassi@gmail.com http://www.linkedin.com/in/abahnassi http://www.slideshare.net/abahnassi Anas Bahnassi PhD RPh 2012 http://bahnassi.coursesites.com http://twitter.com/abahnassi http://www.udemy.com/hospital-pharmacy attribution – non-commercial – share alike